PNMLT and EMG

[Violet M]

Hi Christie,

Wow, sorry you have been through so much. It sounds like you might need a little more information before deciding on a treatment option because it sounds like there's more than one thing going on. So, where is your pain primarily -- is it rectal?

You mentioned that internal myofascial release made you worse -- that is what happened to me too so I discontinued pelvic floor PT, thinking that it was more likely a nerve problem than just pelvic floor muscle tension. I was like Helen -- pressing along the course of the pudendal nerve was very painful.

Some of the options you could consider are to have a 3T MRI following the Hollis Potter protocol to see if there is any scar tissue showing up that could be encasing or entrapping the pudendal nerve or nearby pelvic nerves. You may also want to have an evaluation by one of the pudendal neuralgia experts -- maybe a urogynecologist who can also evaluate the rectocele and guide you in the right direction. Is the rectocele extremely bothersome or is it mostly a minor annoyance? Sometimes pelvic floor repairs can increase your pain levels because the pelvic floor muscles become even more tight but if the rectocele is severe it might have to be dealt with first. You can read some of Calluna's posts because she has experience in this area.

Have you tried using ice yet to help you get to sleep? Many people with pudendal neuralgia find it more helpful than heat because it helps to numb things up. Some women even use it internally in the vagina with frozen balloons or condoms.

What about drugs for neuropathic pain -- like lyrica or gabapentin -- any luck with these? For the feeling of needing to empty your bladder sometimes antidepressants are helpful -- either tricyclics or SSRI antidepressants. I think drugs are just temporary bandaids until you find something more permanent that helps but they can be very helpful.

Keep researching and consider your options carefully before making a decision. Surgery isn't always the answer and it's a permanent thing that can't be undone -- also tends to cause scar tissue. So hopefully you can get several opinions before making any major decisions.

Best,

Violet